Abstract
MINIMALLY invasive cardiac surgery (MICS) is being increasingly performed. 1 Gammie J.S. Zhao Y. Peterson E.D. et al. Less-invasive mitral valve operations: Trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2010; 90 (1401-10.e1) Abstract Full Text Full Text PDF Scopus (270) Google Scholar Several approaches are listed under the term MICS, such as ministernotomy for aortic valve replacement, left minithoracotomy for minimally invasive direct coronary artery bypass, and right anterior minimally invasive thoracotomy (RMIT) principally for mitral or aortic valve surgery. Minimally invasive thoracotomy is associated with intense and prolonged postsurgical pain, which can be equal to that occurring after conventional sternotomy. Pain after RMIT is caused by rib retraction, pectoralis and intercostal muscle dissection, and intercostal nerve lesions. Moreover, this pain is exacerbated by breathing movements, coughing, respiratory physiotherapy, and chest tubes. 2 Furrer M. Rechsteiner R. Eigenmann V. et al. Thoracotomy and thoracoscopy: Postoperative pulmonary function, pain and chest wall complaints. Eur J Cardiothorac Surg. 1997; 12: 82-87 Crossref PubMed Scopus (150) Google Scholar
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